Clinical impact of somatostatin receptor scintigraphy in the management of tumor-induced osteomalacia.
OBJECTIVE
Tumor-induced osteomalacia (TIO) is a rare condition due to phosphate wasting secondary to the release of a phosphatonin, fibroblast growth factor-23. Attempts to identify the tumor by physical examination and/or conventional imaging are sometimes unrewarding. In such cases, somatostatin receptor scintigraphy with octreotide has been successfully proposed.


METHODS
Two case reports and a review of the literature allow to demonstrate the diagnostic usefulness of octreotide and the therapeutic value of somatostatin.


RESULTS
Octreotide studies were positive in 79% of 24 reported TIO, including our 2 cases. In one of our patients with incomplete removal of the tumor, octreotide therapy was unable to improve hypophosphatemia, despite a decrease in fibroblast growth factor-23 levels by 30%. Similar results were achieved in most of the reported cases. Surgical procedures were effective in these cases and resulted in complete clinical and biochemical recovery.


CONCLUSIONS
We highlight the impact of somatostatin receptor evaluation in the management of TIO.
Duet
Michèle
M
Department of Nuclear Medicine, Hôpital Lariboisière, APHP, Paris, University Paris 7 Denis-Diderot, Paris, France. michele.duet@lrb.aphp.fr
Kerkeni
Samar
S
Sfar
Raja
R
Bazille
Cécile
C
Lioté
Frédéric
F
Orcel
Philippe
P
D000008:Abdominal Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000601:surgery; D000328:Adult; D018206:Angiolipoma / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D001859:Bone Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000601:surgery; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000187:drug effects / Q000378:metabolism; D005528:Foot / Q000000981:diagnostic imaging / Q000473:pathology; D006615:Hip / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D017674:Hypophosphatemia / Q000188:drug therapy / Q000209:etiology; D007717:Knee / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use*; D010018:Osteomalacia / Q000000981:diagnostic imaging* / Q000209:etiology; D010257:Paraneoplastic Syndromes / Q000150:complications / Q000000981:diagnostic imaging; D010388:Pelvis / Q000000981:diagnostic imaging / Q000473:pathology; D010710:Phosphates / Q000378:metabolism / Q000627:therapeutic use; D011877:Radionuclide Imaging / Q000379:methods; D017481:Receptors, Somatostatin / Q000819:agonists* / Q000037:antagonists & inhibitors*; D012272:Ribs / Q000000981:diagnostic imaging / Q000473:pathology; D012983:Soft Tissue Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000601:surgery; D013004:Somatostatin / Q000031:analogs & derivatives / Q000493:pharmacokinetics / Q000627:therapeutic use; D051598:Whole Body Imaging
D010710:Phosphates; D017481:Receptors, Somatostatin; D013004:Somatostatin; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23; C081788:pentetreotide; D015282:Octreotide